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Sleep Apnea

What is sleep apnea?

Sleep apnea is a serious, potentially life-threatening condition. It's far more common
than thought. It happens in all age groups and both genders, but it's more common in
men. Over 20 million Americans have sleep apnea.

Sleep
apnea is a breathing disorder characterized by brief interruptions of breathing during
sleep. There are 3 types of sleep apnea:

Obstructive
sleep apnea happens when air can’t flow into or out of the nose or mouth
although efforts to breathe continue.

Central sleep apnea happens
when the brain fails to send the right signals to the muscles to start breathing.
Central sleep apnea is less common than obstructive sleep apnea.

Complex sleep apnea. This is a mix of symptoms
found in both central and obstructive sleep apnea.

Sleep
apnea causes involuntary breathing pauses or "apneic events" during a single night's
sleep. There may be as many as 20 to 30 or more events per hour. Between events you may
snore. But, not everyone who snores has sleep apnea. Sleep apnea may also make you feel
like you are choking. The frequent interruptions of deep, restorative sleep often lead
to early morning headaches and excessive daytime sleepiness.

During the apneic event, you can’t breathe in oxygen or exhale carbon dioxide. This
results in low levels of oxygen and increased levels of carbon dioxide in the blood.
This alerts the brain to resume breathing and cause an arousal. With each arousal, a
signal is sent from the brain to the upper airway muscles to open the airway. Breathing
is resumed, often with a loud snort or gasp. Frequent arousals, although necessary for
breathing to restart, prevent restorative, deep sleep.

Early
recognition and treatment of sleep apnea is important, as it may be associated with:

Irregular heartbeat

High
blood pressure

Heart
attack

Stroke

Daytime
sleepiness

Increased risk of motor vehicle accidents

What causes sleep apnea?

Certain mechanical and structural problems in the airway cause the interruptions in breathing during sleep. Apnea happens:

When
the throat muscles and tongue relax during sleep and partially block the opening of
the airway

When the
muscles of the soft palate at the base of the tongue and the uvula relax and sag, the
airway becomes blocked, making breathing labored and noisy and even stopping it
altogether

In
overweight people when an excess amount of tissue in the airway causes it to be
narrowed

With a
narrowed airway, the person continues his or her efforts to breathe, but air can’t
easily flow into or out of the nose or mouth

Who is at risk for sleep apnea?

Sleep apnea seems to run in some families, suggesting a possible genetic basis. People most likely to have or develop sleep apnea include those who:

Snore loudly

Are overweight

Have high blood pressure

Have some physical abnormality in the nose, throat, or other parts of the upper airway

Use of alcohol and sleeping pills increases the frequency and duration of breathing pauses in people with sleep apnea.

What are the symptoms of sleep apnea?

In
either form of sleep apnea, your breathing pauses a number of times during sleep. These
are called apneic events. There may be as many as 20 to 30 or more events per hour.
Between events, you may snore. But, not everyone who snores has sleep apnea. Sleep
apnea may also cause a choking sensation. When breathing restarts, you may snort or
gasp. These frequent breaks in deep, restorative sleep often lead to headaches
and excessive daytime sleepiness.

Other symptoms include dry mouth or sore throat and problems paying attention.

How is sleep apnea diagnosed?

A
primary healthcare provider, pulmonologist, neurologist, or other healthcare provider
with specialty training in sleep disorders may make a diagnosis and start treatment.
Several tests are used to evaluate sleep apnea, including:

Polysomnography. This test is done in a sleep lab. It records a variety of
body functions during sleep. This includes the electrical activity of the brain, eye
movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen
levels.

Home sleep apnea test. This is a portable device that can diagnose sleep
apnea. Your doctor will arrange for you to take it home to wear during sleep and then
it returned to the office where results are processed.

How is sleep apnea treated?

Treatment will depend on your symptoms, age, and general health. It
will also depend on how severe the condition is.

Oxygen.
Giving oxygen may safely help some people, but doesn't end sleep apnea or prevent
daytime sleepiness. Its role in the treatment of sleep apnea is controversial.

Behavioral changes are an important part of treatment. In mild cases of sleep apnea,
behavioral therapy may be all that is needed. You may be advised to:

Not use alcohol or tobacco.

Not use sleeping pills.

Lose weight if overweight. Even a 10% weight loss can reduce the number of
sleep apnea events for most people.

Use pillows and other devices to help sleep in a side position.

Physical
or mechanical therapy. Continuous positive airway pressure (CPAP) is a device used
nightly. For this treatment, you wear a mask over the nose or mouth and nose during
sleep. Pressure from an air blower forces air through the nose and throat.

Dental appliances. These can
reposition the lower jaw and the tongue have been helpful to some people with mild
sleep apnea, or who snore but don't have apnea.

Orofacial therapy. This can help by improving the tongue
positioning and strengthen mouth and facial muscles.

Surgery. Some people with sleep apnea may need surgery. Examples of these procedures
include:

Surgery to remove adenoids and tonsils, nasal polyps, or other growths or
tissue in the airway, or to correct structural deformities

Surgery to remove excess tissue at the back of the throat (tonsils, uvula, and
part of the soft palate)

Surgery to reconstruct deformities of the upper jaw (maxilla) and lower jaw
(mandible).

Surgery to treat obesity

Nerve
stimulator. A newer treatment option for certain people is called a hypoglossal nerve
stimulator. It's an implanted device that triggers the neck muscle to tighten when
the device detects that the airway is closing during sleep.

Key points about sleep apnea

Sleep apnea is a breathing disorder tjat causes brief times when you stop breathing
during sleep.